How much do life-style factors, such as diet, stress, smoking, alcohol consumption or being over or underweight impact on the ability of an individual or couple to conceive? These were the controversial questions at the heart of Progress Educational Trust’s conference yesterday entitled Fertility Treatment: A Life Changing Event?
There were many speakers, some better than others, and I’m not going to try to cover them all but the tension between the medics and academics and those attempting to fill the emotional and nurturing gaps in the medical model, were evident throughout. In the session on Stress, Zita West talked about the possibility of infertility being ‘all in the mind’ rather than the importance of taking the expensive vitamin and mineral supplements she is famous for, but Nick Macklon from Complete Fertility in Southampton seemed to have her in mind when he promised that good studies of pre-conceptual care are coming (ie. there have not been any good ones to date). More important than supplements (apart from folic acid) is a woman’s diet and as may be imagined, this has a significant influence on very early embryo development. It appears that one featuring Mediterranean foods and oils is the best. Nick Macklin also confirmed that being obese lowers rates of both conceiving and maintaining a pregnancy with one third poorer chance of conception and miscarriage for very overweight women.
I liked counsellor Tracey Sainsbury’s imagery of everyone being born with an invisible suitcase that gradually gets filled with experiences, emotions and patterns of behaviour as we get older. Most of the time the suitcase is closed but contents can be spilled out as and when triggers…like the distress of infertility…arise, and if past stressors have not been dealt with effectively then current pain is sharpened and compounded by the way issues have been faced and managed in the past. She is also right that many people suffering infertility set themselves up for failure by telling themselves that they are not going to get stressed about it. Of course they are stressed…it is very distressing! Recognising this and the losses involved in infertility can be the first step to having realistic expectations and talking about ‘how I feel now’ instead of how I ‘should’ be feeling.
Professor Jacky Boivin from Cardiff helpfully brought us down to earth with her meta-analysis of studies into the impact of stress on the ability to conceive. From this it seems clear that stress does not have a direct effect but it can have quite a strong indirect one. This comes about through people dropping out of treatment before they have had an optimum number of cycles because they can’t bear the stress that it causes them and because the stress of infertility and it’s treatment sometimes causes people to drink and smoke more, thus lessening their chances of conceiving! Stress cannot and does not have a direct impact on the reproductive system itself. Babies continue to be born in the direst and most stressful of situations…war, famine…even concentration camps as we were reminded by a later contributor from the floor. The impact on their future health and that of their descendants is another thing as other speakers reminded us, but stress itself does not suppress the reproductive system. The lesson seems to be that doing lovely things, like having massage and complementary medicine treatments is a wonderful way for a woman to care for herself whilst attempting to conceive, but reducing stress this way is unlikely to actually help with conception…except perhaps for those where medical intervention is marginal and feeling less stressed may lead to more and better sex!
Professor Ellie Lee from the University of Kent documented the huge changes in attitude to women drinking in pregnancy between 1985 and now as measured by media items about the topic. In the eighties the attitude largely was that moderate drinking was a reasonable thing for pregnant women to do and that anyone who said anything different was scaremongering and probably sexist as well. Today most (educated) women are terrified of taking a drink in pregnancy and those trying to conceive often abstain as well, thus affecting their social and emotional relationships with partners and others. As a sociologist Professor Lee recommended moderation in all things and a move away from the risk averse society we have become, including the unhelpful ‘cotton-wooling’ of our children.
Allan Pacey, described by Chair Gillian Lockwood as ‘the face of sperm’ (!) reported on the results of his Chaps project, which seems to have come to the surprising conclusion that smoking and drinking may not be as bad for sperm as previously thought. It appears that the higher the number of swimming sperm in a guy’s ejaculate, then the more fertile he is likely to be. Yes, the smokers in the study did have a higher level of DNA damage, BUT if the same guys had lots of swimming sperm, then fertility was unlikely to be severely compromised. The very droll Neil McLure from Belfast also pointed out that men’s sperm counts vary enormously over time. He reported that laptops and mobile ‘phones don’t seem to have the impact some have thought they might on sperm counts and his research, in slight contrast to that of Allan Pacey, showed that smoking is probably bad (for many other reasons as well as fertility) as is alcohol, but that the evidence is mixed. In response to a question about whether male semen quality is declining generally Professor McClure said that men were fathering fewer children but the evidence for a decline in quality is not there.
Age was the final topic of the day and Professor of Complex Obstetrics Susan Bewley put in a plea for fertility education for older children instead of simply practicing putting condoms on bananas! The most secure age for childbirth is age 20 – 35 and a very clear graph showed that as women age, fertility declines and spontaneous miscarriages go up. Apparently these days fifty-five per cent of conceptions to women over forty involve donated eggs, helping to bust the myth that smiling celebrities in Hello magazine showing off their twins at age 48, have used their own eggs. Speakers from the floor were keen to point out the many factors in modern life that led to pregnancy being delayed in educated women – including not wanting or feeling ready to have a baby before 35. Professor Bewley acknowledged these and said she would never encourage a woman to have a baby before she really wanted to, BUT every woman did need to understand the reality that no matter how young a woman might look on the outside, inside her eggs were ageing in just the same way as her mother and grandmother’s did. Her final message was, ‘Don’t let men waste your time!’ This was actually part of her response to my question about what is happening with women who are able to conceive a fourth or fifth child in the second half of their forties, whilst it seems virtually impossible to conceive a first then. I didn’t get a proper answer to this.
Gillian Lockwood’s solution to women postponing childbearing until later was egg vitrification in a woman’s early twenties, so that when she is ready to have a baby at 40, she has young eggs available to achieve this more easily. Modern vitrification methods make pregnancy following thawing of eggs as successful as fresh eggs. Her final slightly chilling (!) suggestion was egg vitrification as a 21st birthday present from loving parents to their daughter (and she just managed to avoid suggesting it should all happen at her clinic…where she just happens to be a pioneer of such techniques).
A fascinating day. Look out for official reports from this conference on the website of Progress Educational Trust http://www.progress.org.uk/home